Laura J. Martin, MD
Every woman probably has at least one pair: those shoes that you absolutely adore. (Some perhaps have dozens.) My personal downfall is a gorgeous pair of salmon-pink suede Prada kitten heels with a very pointy toe, scored during an amazing sale a few years back.
The problem is, those shoes may be my very literal downfall, because, well, they’re just not good for my feet. One look at them tells you why: How can you squeeze five normal-sized toes into an area barely big enough for a pinky toe?
Whether they’re skyscraper stilettos, open-backed clogs, pointy-toed pumps, or just ballet flats with no arch support, we have so many shoes and so many ways to destroy our feet.
So what types of shoes are worst for your feet, and what are you left with by the time you eliminate all the ones that cause everything from nerve damage to hammertoe to calluses?
You might be surprised at the winner of the Worst Shoe Olympics. According to podiatrist Andrew Shapiro, DPM, a spokesman for the American Podiatric Medical Association, it’s not spike heels or pointy boots. Instead, the worst offender is...
“Women are wearing flip-flops as everyday shoes!” laments Shapiro, who practices in Valley Stream, N.Y. “They’re meant for the beach and the pool, not for everyday walking. They don’t give you any arch support, and don’t protect the foot at all, so it’s prone to injuries.”
Even for an occasional stroll, flip-flops might be fine, if you don't overdo it, says John Anderson, MD, an associate professor of surgery at the University of Michigan College of Human Medicine and co-chair of the American Orthopaedic Foot and Ankle Society’s Public Education Committee.
“But a lot of people get caught up in the moment and try to do things flip-flops aren’t designed for: running for a train, or jumping, or playing Frisbee or touch football in the backyard," Anderson says. "We see a lot of injuries from improper use of flip-flops, and Crocs as well.”
Among the woes of misworn flip-flops, Shapiro says, are scraped feet, strained ankles, and broken toes from falling right out of the shoe, as well as chronic problems due to lack of support, like tendonitis and plantar fasciitis.
The solution: Unless you’re on the beach, wear real sandals, not flip-flops -- the kind with a strap in the back that at least holds your foot inside the shoe.
Coming in second in our Bad Shoe Sweepstakes is...
But you probably already knew that, right?
It’s pretty obvious that the higher the heel, the more out of alignment your foot is. Feet just aren’t made to be jammed into that position for long periods of time. So how high is too high, anyway?
“Anything higher than about two inches causes a problem,” Shapiro says. “The Achilles tendon shortens when the foot is in a high heel, so if you wear them too much, that tendon can become chronically shortened and you have Achilles tendonitis.”
Spike heels also put an abnormal amount of pressure on the ball of the foot. “The fat under the ball of the foot starts to thin out from the pressure, and that’s the one place on your body that you want a nice chunk of fat,” he says. “You can end up with something called metatarsalgia, an acute pain in the ball of the foot that can become chronic, or even stress fractures from all the pressure and hammer toes from the abnormal positioning.”
It’s not just your feet that can pay the price. “If your feet hurt, you’ve lost your foundation. So if you find yourself limping because your feet hurt, everything above the foot will be affected too,” says Anderson. “Your gait will be changed, and because of that, you’ll stress your knees, back, and hips. Everything above the foot has to adjust to what’s going on down below.”The solution: Wear your highest heels in moderation, only for special events, and slip them off on the way home. You can also relieve some of the pressure on the ball of your foot by wearing an over-the-counter or custom-made gel cushion. “And don’t combine sky-high heels with a pointy toe,” Shapiro warns. “Look for something that’s wide and roomy in the toe box!”
Which brings us to...
These beauties can cause some of the same injuries as high heels -- even more so when the shoe is both high and pointy.
“In addition to metatarsalgia and hammer toes, pointy-toed shoes can cause neuroma, an inflammation of the nerve between the toes,” Shapiro says. “It’s most common between the third and fourth toes, but could happen between any of them. The pinched and inflamed nerve causes pain and burning, and may need to be treated with injections, physical therapy, or even surgical removal of the neuroma.”
The solution: a wider toe box. There’s really nothing you can do to improve a shoe that squeezes your feet into an unnatural shape, Shapiro says. If you must wear them, as with sky-high heels, make it only on occasion and not every day to the office.
It’s not just the obvious offenders that can be bad for your feet, though.
You’re not teetering on spiked heels and pressing your foot into tight toes. Your feet are planted firmly on the ground in a shoe that has a lot of give. What's not to like?
Well, that “give” is precisely the problem.
“Ballet flats generally lack support, lack cushioning, and don’t allow the foot to function the way it should,” Shapiro says. “They’re an improvement on the flip-flop in that they protect the foot, but they carry the same risk of tendonitis, plantar fasciitis, and all the other things you see with lack of support. They’re just not meant for everyday wear.”
The solution: You can choose a flat that resembles a ballet flat, but has a real sole and support around the heel counter (the part of the shoe that wraps the heel). But if you can fold it up and stuff it in your purse, that’s a shoe that doesn’t give you much support.
Other shoes that leave you hanging are...
“I see a lot of problems with backless shoes,” Shapiro says. “The toes start to grab the shoe to get support, and a lot of women wind up with hammertoes because of that. You can also develop calluses or breaks in the skin because the shoe is constantly tapping the heel.
So what does that leave you with? Well-designed, well-fitted athletic shoes are always good, of course, but you’re hardly going to wear those to most offices, a family wedding, or a big date.
For daily office wear, Shapiro recommends either a dressy flat or a pump with no more than a 1-1.5 inch heel. “You’re looking for good support around the heel counter, a good arch support, and a wider toe box,” he says. “Ideally, there’s also a lace or buckle closure to support the foot.”
“Hundreds of millions of dollars of research come down to the fact that if shoes feel comfortable when you put them on, they’re probably OK, but if they hurt, you shouldn’t wear them,” Anderson says. “It’s really that simple.”
SOURCES:Andrew Shapiro, DPM, podiatrist in Valley Stream, N.Y.; spokesman, American Podiatric Medical Association.John Anderson, MD, associate professor, surgery department, Michigan State University College of Human Medicine; spokesman, American Orthopaedic Foot and Ankle Society, East Lansing, Mich.
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